Did you develop high blood pressure overnight? 130/80, the standard for high blood pressure in Chinese adults has been lowered! At least 7.64 million patients have been added in Zhejiang, should medication be taken immediately?

On the morning of November 13, the "Chinese Hypertension Clinical Practice Guidelines" (hereinafter referred to as the new version of the guidelines) was released. The new version of the guidelines made important adjustments to the diagnostic thresholds for hypertension, blood pressure reduction targets for different populations and other contents that are of clinical concern, and formed 44 key clinical issues and 102 recommendations for hypertension.

The new version of the guidelines recommends lowering the diagnostic threshold for hypertension in Chinese adults from 140/90 mmHg to 130/80 mmHg, which has attracted public attention. This means that a large number of sub-healthy people who were once defined as "pre-hypertension" will be diagnosed as hypertensive patients.

What are the highlights of the new version of the guidelines? What is its significance for the clinical diagnosis and treatment of hypertension? Do people with blood pressure of 130/80 mmHg need immediate treatment? Express reporters interviewed authoritative experts from many hospitals in our province and asked them to interpret the new version of the guidelines in combination with clinical practice.

No symptoms are more terrible than symptoms

Lowering the diagnostic criteria for hypertension

Helps to awaken the public awareness

(Professor Wang Jianan, Vice Chairman of the Chinese Medical Association's Cardiology Branch, a famous cardiovascular expert in my country, and Professor of Zhejiang University Second Hospital)

In the past five years, the international medical community has been lowering the diagnostic criteria for hypertension. The fundamental purpose is to increase the public's attention to controlling hypertension. In the process of clinical diagnosis and treatment, we often encounter patients or family members who have a vague understanding of hypertension. They think that if the blood pressure is a little high but there are no symptoms, there is no need to treat it. Some people even think that taking medicine may have side effects and are afraid of taking medicine for life. In fact, these are all cognitive misunderstandings. In fact, it is more terrible to have no symptoms than to have symptoms. Patients without symptoms do not seek treatment and cannot control it in time, which may bring many sequelae. As for patients' concerns about taking medicine, the side effects of cardiovascular drugs and antihypertensive drugs are currently very low, and blood pressure is more harmful to the human body. Some patients and their families are overly concerned about the side effects of taking medicine, but not the harm caused by hypertension itself.

Hypertension is the culprit for atherosclerosis, and is also the culprit for stroke and myocardial infarction. So I think that the Chinese Cardiology Society's decision to lower the diagnostic criteria for hypertension is very helpful in awakening the public's awareness, and I strongly support it. Of course, establishing a healthy lifestyle, eating a reasonable diet to control weight, increasing aerobic exercise, quitting smoking and limiting alcohol, and maintaining a long-term calm state of mind are important factors in promoting lowering blood pressure.

For earlier control

Positive effects on blood pressure in young and middle-aged people

(Fu Guosheng, chief physician, chairman of the Cardiovascular Disease Branch of the Zhejiang Medical Association and director of the Department of Cardiology at the Run Run Shaw Hospital of Zhejiang University)

Hypertension is not only the chronic non-communicable disease with the largest number of patients, but also the primary and modifiable risk factor for the increased risk of cardiovascular disease and death among residents. It is a consensus in the industry that as blood pressure increases, the incidence of cardiovascular and cerebrovascular diseases also gradually increases, in a positive correlation.

Looking at the current hypertension guidelines at home and abroad, there are still many controversies about the diagnosis and treatment of hypertension, such as the diagnostic criteria for hypertension, the blood pressure target values ​​for different hypertensive populations, when to start antihypertensive drug treatment, the timing of screening for secondary hypertension and how to screen, etc. These issues are urgent to be resolved in the field of hypertension and are also the key to improving the level of hypertension diagnosis and treatment in my country. The release of the new version of the guidelines provides a "Chinese" answer to these urgent issues to a certain extent.

The new version of the guidelines lowers the diagnostic threshold to 130/80 mmHg, which will include more patients in the hypertension group, and the clinic may be busy for a long time. The key to whether this group of people should be treated is whether they have clinical symptoms and cardiovascular and cerebrovascular complications. If they do not have these, they can be treated with non-drug methods, such as adjusting their lifestyle and regularly monitoring their blood pressure.

With the improvement of economic living standards, the number of hypertensive patients in my country tends to be younger. One of the important significances of the new guidelines is that it moves the intervention front of non-drug treatment forward, which will play a positive role in the overall control of hypertension in my country, especially in controlling the increase in blood pressure in young and middle-aged people at an earlier stage.

With a more positive attitude and stricter standards

Manage blood pressure in patients with hypertension

(Huang Jinyu, Vice Chairman of the Cardiovascular Disease Branch of the Zhejiang Medical Association and Secretary of the Party Committee of the Hangzhou First People's Hospital)

As time goes by, the diagnostic criteria for hypertension are constantly changing. In 2017, the American College of Cardiology/American Heart Association Hypertension Guidelines lowered the diagnostic criteria for hypertension to systolic blood pressure of 130 mmHg and/or diastolic blood pressure ≥80 mmHg. On November 13 this year, China's new version of the guidelines was released, which aimed to carry out lifestyle interventions for people with blood pressure of 130-139/80-89 mmHg and initiate antihypertensive drug treatment when non-drug treatment is ineffective, in order to reduce the important window period for adverse consequences of hypertension, which is generally cost-effective.

Studies have shown that among people aged 18 and above with no history of cardiovascular disease and systolic blood pressure of 130-139 mmHg, the risk of cardiovascular disease decreases by 11% for every 5 mmHg decrease in systolic blood pressure. National survey data show that among adults aged 18 and above in my country, 23.2% have systolic blood pressure of 130-139 mmHg and/or diastolic blood pressure of 80-89 mmHg, with an estimated total number of nearly 243 million people, and the population in this blood pressure range is mainly young and middle-aged people aged 18-54. According to the latest international guidelines for the initiation of antihypertensive drug treatment, among adults aged 35 and above in my country, 22.7% of people with systolic blood pressure of 130-139 mmHg and/or diastolic blood pressure of 80-89 mmHg need antihypertensive drug treatment, with an estimated total number of 39.9 million people. According to China's latest drug prices and medical insurance system, for adults aged 35 and above with systolic blood pressure of 130-139 mmHg and/or diastolic blood pressure of 80-89 mmHg and without cardiovascular disease, it is cost-effective to take antihypertensive drug treatment in the next 10 years or even for life.

Except for elderly patients over 80 years old and those who are obviously frail or have a short life expectancy, there is currently sufficient evidence for the effectiveness and safety of a blood pressure control target of <130/80 mmHg.

In order to further reduce the mortality and disability rates of hypertension, we should follow new evidence, adjust treatment strategies in a timely manner, and manage blood pressure in hypertensive patients with a more proactive attitude and stricter standards.

Use potassium-rich low-sodium salt instead of regular table salt

Non-drug interventions such as quitting smoking, limiting alcohol consumption, and controlling weight are also important

(Honorary Chairman of the Hypertension Committee of Zhejiang Biomedical Engineering Society, Chief Physician Hu Shenjiang of the Department of Cardiology, Zhejiang University First Hospital)

The new version of the guidelines clearly stated for the first time that "hypertensive patients should use potassium-rich, low-sodium salt instead of ordinary table salt, and control daily salt intake to less than 5 grams." This is one of the highlights of the release of this guideline and will further promote non-drug treatment of hypertension.

Excessive sodium intake and insufficient potassium intake are important risk factors for hypertension. In my country, about 3/4 of sodium salt intake comes from cooking salt. Reducing the sodium content in household cooking salt has always been an important strategy for antihypertensive treatment. However, the dietary sodium salt intake of Chinese residents has always been high. This time, it is recommended to use potassium-rich and low-sodium salt. If the same amount of salt is consumed, not only can the intake of sodium chloride be reduced, but the intake of potassium chloride can also be increased. Ordinary people can effectively lower their blood pressure in their daily lives.

In addition to dietary intervention, other non-drug interventions for patients with hypertension are also important.

First, quit smoking and limit alcohol consumption. Every time you smoke a cigarette, your blood pressure will continue to rise for 40 minutes, so you should quit smoking. In addition, drink less alcohol and other stimulating beverages and avoid excessive drinking. Men should not drink more than 20 grams per day, and women should not drink more than 10 grams per day.

The second is to control weight. Obesity is more likely to lead to an increase in diastolic blood pressure, so patients with hypertension should also pay attention to a low-fat diet and control their body mass index [BMI = weight (kg) / height (㎡)] between 18 and 23.9.

The second is exercise intervention. For example, brisk walking for 30 to 40 minutes every day until the body sweats slightly; if you are in good physical condition or have a good physical exercise foundation, you can choose swimming, jogging, cycling and other sports.

One point that needs to be emphasized is that weight loss is a hard indicator of whether non-drug intervention is effective for hypertensive patients with excessive body mass index. If the weight does not decrease after a period of non-drug intervention, it means that the intervention is not adequate.

A large number of clinical studies have confirmed

Blood pressure within the range of 130-139/85-89 mmHg

Target organ damage occurred to varying degrees in the population

(Chief Physician Jiang Chenyang, Vice Chairman of Zhejiang Province Electrophysiology and Pacing Branch, Deputy Director of the Department of Cardiology, Zhejiang University Run Run Shaw Hospital)

From the perspective of clinical medical workers, hypertension is a major risk factor for many cardiovascular and cerebrovascular diseases. The shift in the prevention and control ports brought about by the reduction of the diagnostic threshold is of great significance, and its essence is to emphasize early prevention and early treatment. More and more people are controlling their hypertension, which, to a certain extent, means working on the source of the disease. The serious complications and target organ damage caused by the untimely intervention of hypertension may not occur, or at least will occur less frequently. For people who have not yet met the diagnostic criteria for hypertension, this is also a "wake-up call". Hypertension is actually not far from us, and corresponding changes should be made in lifestyle as soon as possible.

In my personal actual clinical practice, I actually set the patient's blood pressure control target value at ≤130/80 mmHg as early as 20 years ago, because a large number of clinical studies have also confirmed that people with blood pressure in the range of 130-139/85-89 mmHg have already experienced target organ damage to varying degrees and require early intervention.

Another point is that in clinical practice, it is found that many patients will increase or decrease medications on their own when their blood pressure fluctuates. In fact, the human body itself has a certain regulatory effect on blood pressure. Leaving it to the body to self-regulate to a certain extent on the basis of unchanged dosage is much more beneficial to the body than "rough" regulation by increasing or decreasing medications. It should be reminded that antihypertensive treatment strives to stabilize blood pressure and meet the standard. Do not stop taking medication or increase or decrease the dosage at will. Changes in dosage must be made under the scientific guidance of professional doctors, because target organ damage caused by blood pressure fluctuations exceeds simple hypertension.

Diagnosis of hypertension

Measures should be taken as soon as possible to prevent further damage

(Wang Lihong, Vice Chairman of the Cardiovascular Disease Branch of the Zhejiang Medical Association and Director of the Department of Cardiology at Zhejiang Provincial People's Hospital)

The United States adjusted its diagnostic criteria for hypertension two years ago, which caused a lot of controversy at the time because according to the adjusted criteria, half of adults would become hypertensive patients.

One of the key points of the controversy is: With such a large number of people with high blood pressure, will it cause panic among the public? In fact, the new standards set by the new version of the guidelines are more targeted at people with borderline high blood pressure, and their main purpose is to increase the attention of this group of people to their health conditions.

With the development of medicine, people's awareness of diseases has been increasing in recent years. If patients with hypertension are not intervened, a series of problems will arise later, such as myocardial hypertrophy, cerebral vascular sclerosis, stroke, renal failure, etc. These diseases are very serious and even fatal.

For those whose blood pressure is at the critical value, if they can pay attention to it as soon as possible and change their lifestyle, especially their diet and exercise habits, there is still a great possibility of controlling their blood pressure, which has great positive significance for them.

After the new standard came out, many people said that they "became hypertensive patients overnight", but there is no need to panic too much, because the diagnostic standard and treatment are two different things. A diagnosis of hypertension does not mean that you have to take medicine immediately, unless you have diabetes, coronary heart disease or other risk factors. In the absence of other risk factors, patients with critical blood pressure usually only need to improve their physical condition through daily adjustments, such as quitting smoking and drinking, and exercising appropriately.

The tightening of standards can make people more aware of the disease and take measures as early as possible to prevent greater damage.

Blood pressure reaches 130/80 mmHg

Do you want to take medicine?

Not only ordinary people are concerned, but also clinicians are concerned

How should patients with blood pressure values ​​reaching 130/80 mmHg respond? Should they start medication treatment immediately or start with lifestyle changes?

Chen Wen'ai, chief physician of the Department of Cardiology at the Second Hospital of Zhejiang University, said: "Today I met a colleague who is in his 50s. His systolic blood pressure is 136 mmHg and his diastolic blood pressure is 80 mmHg. Seeing that the diagnostic criteria for hypertension have been lowered, he came to consult whether his condition requires medication.

"After evaluating his condition, I suggested that he didn't need to take medicine for the time being. Because I found that his blood pressure had not been elevated for a long time, his usual diet structure also needed to be adjusted.

"I told him that he should observe for a while. Although he doesn't need to take medicine, he should monitor his blood pressure. This is the first point. If the blood pressure is above 140/90 mmHg, he needs to take medicine in time. For blood pressure values ​​like yours, you can observe for a while. I also reminded him that although he doesn't need to start taking medicine right away, he should pay attention to monitoring his blood pressure every day. It is best to measure blood pressure before breakfast and before dinner every day. He should also pay attention to adjusting his lifestyle and diet structure, and try to control his blood pressure to the standard through lifestyle intervention."

Chen Wen'ai, chief physician of the Department of Cardiovascular Medicine at the Second Hospital of Zhejiang University, said that when to start drug treatment for patients with hypertension is an issue that not only concerns the general public but also clinicians.

The guidelines suggest that patients with blood pressure above 140/90 mmHg need to start drug treatment immediately.

For people with systolic blood pressure of 130-139 mmHg and diastolic blood pressure of 80-89 mmHg, different conditions should be considered. If there are hypertensive people with clinical complications, such as cerebral hemorrhage, cerebral infarction, or cardiovascular and cerebrovascular diseases such as coronary heart disease, heart failure, atrial fibrillation, or target organ damage, medication should be used under the guidance of a doctor.

In addition, if the blood pressure reaches 130/80 mmHg and there are three or more cardiovascular risk factors, such as women over 55 years old and men over 45 years old; and there are high-risk factors such as smoking, hyperlipidemia, hyperglycemia, obesity, etc., a clinical doctor is also required to evaluate and use medication for treatment.

If there are no clinical complications, target organ damage or high-risk factors for cardiovascular and cerebrovascular diseases, it does not mean that medication should be given immediately. Generally speaking, we can first adjust the blood pressure status through healthy diet and exercise intervention and advocate a healthy lifestyle. Through changes in lifestyle and eating habits, observe for 3-6 months. If the blood pressure is still higher than the standard, then consider including it in the scope of medication treatment.

According to 130/80 standard

Zhejiang will at least

7.64 million more patients with hypertension

Yu Wei, deputy director of Zhejiang Cardiovascular and Cerebrovascular Disease Prevention and Treatment Research Center, director of Zhejiang Hospital Hypertension Center and chief physician, said that according to the new standards released in the guidelines, it is estimated that the number of hypertensive patients in the country will increase by 243 million, and this group is undoubtedly very large.

"The formulation of the new standard is supported by evidence from evidence-based medicine." Yu Wei said that although hypertension may not cause symptoms, it is an important risk factor for cardiovascular, cerebrovascular and kidney diseases. If it is not controlled, it will cause serious complications such as stroke, myocardial infarction and renal failure. If blood pressure is well controlled, the incidence of cardiovascular disease and the risk of death will be significantly reduced, especially the risk of stroke will be greatly reduced.

In 2017, Express News interviewed the Zhejiang Cardiovascular Disease Prevention and Treatment Research Center and learned that according to the 140/90mmHg standard, the prevalence of hypertension among people over 15 years old in the province is 25.0%, and if it is based on the 130/80mmHg standard, the prevalence is 40.8%. Combined with the statistical data of the sixth census, it is estimated that there are about 7.64 million people in Zhejiang with blood pressure values ​​between 130/80-139/89mmHg.

Among the hypertensive population in Zhejiang

About 40% of the population are middle-aged and young people aged 35 to 54.

According to data released by Life Times: 80% of strokes are related to high blood pressure. If high blood pressure is lowered, the incidence of stroke can be reduced by 35%-40%; about 50% of patients with coronary heart disease have hypertension. If blood pressure is controlled within a reasonable range, the probability of myocardial infarction can be reduced by 14%; among patients with heart failure, 91% have high blood pressure, and controlling blood pressure can reduce the incidence by 55%.

"my country is a country with a high incidence of stroke. One important significance of the new standards in the guidelines is to move the threshold of prevention forward so that more hypertensive patients can be detected early, intervened early, and benefit early."

Of course, some people have raised questions: Will the adjustment of the diagnostic standards for hypertension cause panic among people and increase the burden and pressure on medical institutions?

In this regard, Yu Wei believes that early stage hypertension is often just a functional change in the body, and there is a greater chance of correction through intervention. For patients without organ damage and clinical complications, improving unhealthy lifestyles will be more effective in lowering blood pressure.

According to data from Zhejiang Province in 2021, the prevalence of hypertension among people over 18 years old is 25.77%, and the prevalence of hypertension increases significantly after the age of 35. According to the adjusted standards, the young and middle-aged population aged 35 to 54 accounts for about 40%. If this group of people can effectively lower their blood pressure, they will benefit more from reducing the risk of cardiovascular and other diseases.

Patients with three or more risk factors and those who already have hypertension complications or target organ damage are high-risk patients, currently accounting for about 22.7% of the patient population. For this group of people, lifestyle intervention alone is not enough, and targeted drug treatment is also required.

The youngest patient was only in his teens

Hypertension is becoming younger

"High morbidity, high mortality and high disability are the three terrible characteristics of hypertension. For patients with hypertension, once they are combined with adverse factors such as high stress, irregular diet and staying up late, it will induce a very dangerous condition."

Yu Wei said that with the change of modern lifestyle, the incidence of hypertension is on the rise in younger people. The youngest hypertensive patient seen in the outpatient clinic was only in his teens, and there are also many hypertensive patients in their 20s.

Work stress, heavy mental burden, irregular life, staying up late for a long time, insufficient sleep or rest, etc. can all cause high blood pressure. Some bad living habits, such as eating a lot of barbecue, drinking, smoking, etc., can also affect blood pressure. In addition, many people become fat at a young age, which increases the risk of high blood pressure.

"Hypertension should not only be treated, but also prevented. Improving the attention to non-drug intervention can bring huge health benefits to individuals and society, and even reduce the incidence of hypertension." Yu Wei reminded that as a patient with hypertension, you should go to a specialist hospital for diagnosis and treatment as soon as possible and regular monitoring to identify the cause of hypertension and effectively maintain blood pressure within the normal range. You should also have a physical examination every year to check whether various indicators related to hypertension are abnormal, so as to detect early lesions of cardiovascular and cerebrovascular diseases caused by hypertension, such as proteinuria, carotid atherosclerotic plaques, and cardiac hypertrophy. Early intervention can curb the occurrence and development of cardiovascular and cerebrovascular diseases at the source.

Generally speaking, adults over 18 years old should measure their blood pressure at least once a year, and children and adolescents should also measure their blood pressure once a year. You can measure your blood pressure at home, or go to the hospital to measure your blood pressure in the clinic, or you can choose a more accurate dynamic blood pressure monitoring test.

Different people have different blood pressure management methods

These highlights are also worth noting

Chen Wen'ai, chief physician of the Department of Cardiovascular Medicine at the Second Hospital of Zhejiang University, introduced that in addition to the adjustment of the diagnostic standards for hypertension, the new version of the guidelines also includes many detailed adjustments, which are closely related to how people control their blood pressure in their daily lives.

For example, in the diagnosis and management of hypertension, the new guidelines mention the use of dynamic blood pressure for diagnosis and home blood pressure measurement for assessment, emphasizing the importance of monitoring blood pressure at home.

The new version of the guidelines also emphasizes non-drug intervention methods for hypertension. In addition to promoting diet and exercise, this time it provides clear guidance on how to lower blood pressure in daily life, including weight loss, smoking cessation, exercise, and specific details such as which form of exercise to use, time and frequency. It is more targeted and more operational, and is very in line with the daily blood pressure management needs of ordinary people.

The new version of the guidelines also provides detailed guidance on how to manage blood pressure for hypertension with other complications. For example, hypertension with obesity, hypertension with stroke, hypertension with coronary heart disease, hypertension with diabetes, etc. Because the management methods of blood pressure are different for people with different diseases and ages. For example, for the elderly over 80 years old, the systolic blood pressure should be lowered to 140 mmHg first, and if tolerated, it can be lowered to <130 mmHg.

The new version of the guidelines also instructs clinicians to select drugs that not only effectively control blood pressure, but also protect the patient's target organs and choose treatment plans that are more beneficial to the patient. Moreover, the medication basis provided in the guidelines is well-documented and authoritative. It can provide a reference for clinicians to select drugs and guide clinicians to conduct more standardized diagnosis and treatment.

In addition, the new version of the guidelines also mentions the diagnosis and treatment of secondary hypertension. Each situation that may lead to secondary hypertension and how to screen for it have been discussed repeatedly and in detail. Because many diseases can cause high blood pressure, the purpose of screening is to identify the cause. Among all hypertension, about 5% of hypertension is caused by other diseases, such as endocrine diseases, kidney disease, renal artery stenosis, sleep apnea hypopnea syndrome, etc. As long as the cause of this type of hypertension is removed, the blood pressure can return to normal, which is called secondary hypertension.

Generally speaking, when young people have unexplained high blood pressure, they first need to rule out secondary hypertension. However, secondary hypertension only accounts for a small part and belongs to the "minority". Another 95% of hypertension has no clear cause and is the result of a combination of genetic and environmental factors, which is called primary hypertension. Except for a small number of patients with mild hypertension who can lower their blood pressure by adjusting their lifestyle, reduce or even stop taking medication under the guidance of a doctor, most patients need to take medication for life.

Orange Persimmon Interactive Reporter Jin Jing Yu Qianqian Zhang Huili Lin Lin Zhang Jing

Correspondents: Wang Rui, Zhu Shiyi, Fang Xu, Chen Dan, Li Wenfang, Yang Taoyu, Wang Wenting